LOCUST STREET RESOURCE CENTER (NPI# 1558456210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558456210 |
| Entity Type | Organization |
| Organization Name | LOCUST STREET RESOURCE CENTER |
| Other Organization Name | MACOUPIN COUNTY MENTAL HEALTH |
| Practice Address |
320 South Locust Street Carlinville IL 62626 |
| Practice Telephone | 2178543166 |
| Practice Fax Number | 2178549729 |
| Mailing Telephone | 2178543166 |
| Mailing Fax Number | 2178549729 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DOUGLAS KILBERG (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2178543166 |
| Authorized Official Credential | LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Macoupin County Mental Health | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598307712 | Locust Street Resource Center | Clinic/Center | 320 S Locust St, Carlinville, IL 62626-1648 | 2019-10-09 |
| Street Address |
320 SOUTH LOCUST STREET |
| City | CARLINVILLE |
| State | IL |
| Zip Code | 62626 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043482748 | Sherry Lynn Kalicak | Counselor | 320 South Locust Street, Carlinville, IL 62626 | 2008-04-02 |
| 1669674214 | Brenda I Beanblossom | Counselor | 320 South Locust Street, Carlinville, IL 62626 | 2007-06-05 |
| 1417023870 | Lisa Hauter | Social Worker | 320 South Locust Street, Carlinville, IL 62626 | 2006-11-28 |
| 1174695290 | William Anderson | Counselor | 320 South Locust Street, Carlinville, IL 62626 | 2006-11-14 |
| 1972675098 | Joseph P Kravanya | Counselor | 320 South Locust Street, Carlinville, IL 62626 | 2006-11-14 |
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|---|---|---|---|---|
| 1710521984 | Cottages At Carlinville, Inc | Assisted Living Facility | 18804 Rt. 4, Carlinville, IL 62626 | 2019-10-31 |
| 1184266348 | Susan Lynne Fite | Pharmacist | 18600 Shipman Blacktop Road, Carlinville, IL 62626 | 2019-10-09 |
| 1669013215 | Rebecca Lynn Sanson | Pharmacist | 18600 Shipman Blacktop, Carlinville, IL 62626 | 2019-10-04 |
| 1497396048 | Jill Louise Kasting | Pharmacist | 18600 Shipman Blacktop Rd, Carlinville, IL 62626 | 2019-10-04 |
| 1134561822 | Fenton Family Chiropractic PC | Chiropractor | 490 West Side Square, Carlinville, IL 62626 | 2013-07-23 |
| 1992020499 | Carlinville Area Hospital Association | Clinic/Center | 1115 Morgan Street #2, Carlinville, IL 62626 | 2010-03-29 |
| 1730213026 | Carlinville Medical Clinic, Inc. | Nurse Practitioner | 604 N. Broad, Carlinville, IL 62626 | 2007-03-16 |
| 1720155906 | Rodney Lee Bailey | Dentist | 201 Mccausland, Suite A, Carlinsville, IL 62626 | 2006-11-30 |
| 1255412599 | Nicolas E Kravanya Dmd LLC | Dentist | 204 Oakland Ave, Carlinville, IL 62626 | 2006-10-17 |
| 1669574562 | John A Lapp | Optometrist | 300 North Broad, Carlinville, IL 62626 | 2006-09-01 |
| Find all providers in zip 62626 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700330545 | Locust Street Resource Center Cila #1 | Clinic/Center | 124 W Buchanan St, Carlinville, IL 62626-1027 | 2016-08-10 |
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| Find all providers with the same taxonomy | ||||
| City | CARLINVILLE |
| Zip Code | 62626 |
Please comment or provide details below to improve the information on LOCUST STREET RESOURCE CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.